经胃镜食管曲张静脉结扎术麻醉的优化选择

Optimum selection of anesthesia in pations undergoing gastroscopic esophageal varices ligation

目的通过观察静脉麻醉或静脉联合表面麻醉下经胃镜行食管曲张静脉结扎术(下称结扎术),比较出最有利于医患双方的麻醉方法。方法选择100例肝硬化拟行结扎术的患者,随机分成静脉麻醉组(I组)和静脉联合表面麻醉组(ToI组),每组50例,观察在两种方法下患者生命体征的变化、临床表现、丙泊酚首量和总量、操作、唤醒及清醒时间。结果I组操作中的MAP较麻醉前和该时点的ToI组有所降低,差异有显著性(P<0.05)。ToI组各时点生命体征差异无显著性(P>0.05),无严重不良反应,视野祛泡率更高(P<0.05),丙泊酚首量和总量更少(P<0.05),唤醒及清醒时间更短(P<0.05)。结论静脉联合表面麻醉方法因丙泊酚用量更少,生命体征更平稳,更利于患者恢复和医师操作,可作为经胃镜食管静脉曲张结扎术患者的首选麻醉。

[Objective] To select the most beneficial anesthetic method to patients and doctors ,after comparision, during gastroscopic esophageal variceal ligation under intravenous anesthesia or combined with topical anesthesia. [Methods] 100 cirrhotic patients undergoing ligation were divided into intravenous anesthesia group（I group） and intravenous combined with topical anesthesia group（ToI group） randomly, 50 persons each. Under two methods, the change of vital signs, the clinical expression, the induction-and total doses of propofol, the time of operating, awakening and regaining consciousness were all recorded. [Results] There were more significant reduction in MAP during operating than pre-anesthesia in I group, and than in same time in ToI group, statistically （P 〈0.05）. There were no significant differences in vital signs （P 〉0.05）, no serious adverse reaction, smaller induction-and total doses of propofol （P 〈0.05）, shorter time of awakening and regaining consciousness （P 〈0.05）, the rate of dispelling saliva bubbles of operating vision was higher （P 〈0.05）, in ToI group than in I group. [Conclusion] The intravenous combining with topical anesthesia is the first selection method of patients with gastroscopic esophageal variceal ligation, because of it＇s advantages of smaller dose of propofoll, more smooth change in vital signs, more beneficial to patient＇ s recovering and doctor＇s operating and so on.